The lines at clinics, hospitals and pharmacies seemed endless. My people, the people of Datapolis, were growing wearier by the day… The targeted, on-time communications intended to inform citizens about new healthcare options and relieve stress on the system were arriving late, or being delivered to the wrong consumers. And
The League of Analytic Heroes is growing. With the addition of each new member, we are better able to combat the chaos of big data. Illumino and Magnacomm are eager to welcome their newest team member. Keep your eyes on www.analyticheroes.com for his arrival. He's already got his eye on
It is becoming clear that a fair percentage of the health care community, particularity outside of the United States, are uncomfortable using the word, “fraud.” Instead, you see the words "risk" and "error" used more often to describe fraud. There appear to be many different reasons for the discomfort with
The men, women and children of Datapolis are falling ill at an alarming rate, forcing me to turn my attention away from my ongoing battle with Obscuro and toward helping the Datapolis Council of Elders distribute its medicine before it is too late. As it happens, just as we most
In most of the articles and press pieces that speak of health care fraud, the topic is usually covered in broad terms regarding the type or activity that has taken place: over-billing to Medicare/Medicaid, services billed and not delivered, over subscription of medication (by members or Pharmacies), and the list
When discussing fraud and abuse, it often (very often) becomes a philosophical discussion of whether aberrant activities are fraudulent or abusive. The quick difference being that fraudulent is intentional and abuse is not. The distinction quickly becomes an issue of legal and illegal as opposed to right and wrong. What
For the past year, I’ve had the pleasure of serving on the communications team of the National Collaborative for Bio-Preparedness (NCB-P), of which SAS is a partner and the analytics provider. That experience was heavy on my mind as I recently watched the film Contagion. I may drop some minor
As part of the staffing efforts for the new SAS Center for Health Analytics and Insights (CHAI), SAS recently hired Dr. Graham Hughes, MD, as the company’s first Chief Medical Officer (CMO). When I heard the news, I sent a few questions to Graham to learn more about the new
Due to the rapid changes in both the health care market and more specifically the amount of fraud being committed in it, it is even more important than ever to maintain some degree of life cycle management to update the analyses used to detect and identify aberrant activity. However, many
In the health care field, the impact of fraud, waste and abuse on payers -- whether insurance companies, government agencies or self-insured employers -- is enormous. Fraud losses weaken a payer’s financial position, with fraud loss estimates rivaling net income. Fraud losses feed the escalating care cost curve, undermining a
